OBJECTIVES: To evaluate the risk factors for postoperative vasopressor requirement among patients with pheochromocytoma undergoing retroperitoneal adrenalectomy. The primary outcome was postoperative hypotension requiring vasopressor support.

DESIGN: A single-center retrospective observational study.

SETTING: At a university hospital.

PARTICIPANTS: Adults who underwent unilateral adrenalectomy for pheochromocytoma between October 2015 and February 2020.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Overall, 201 patients were included. Postoperative vasopressor requirements were observed in 39 (19.4%) patients, and were associated with baseline coronary artery disease (CAD) (odds ratio [OR] 6.21, 95% CI) 2.48-15.52; p = 0.0001), maximal systolic blood pressure (maxSBP) >195 mmHg (OR 3.71, 95% CI 1.53-8.95; p = 0.0035), and >5.1-fold increase in the upper limit of normal values for baseline adrenergic activity (OR 4.9, 95% CI 1.93-12.55; p = 0.0008). The area under the receiver operating characteristic curve of the predictive model was 0.804 (95% CI 0.742-0.856).

CONCLUSION: A MaxSBP >195 mmHg, baseline adrenergic activity >5.1-fold increase in the upper limit of normal values, and baseline CAD could predict postresection requirements for vasoactive support. Prospective multicenter international studies are required to develop and validate universally accepted predictive models for postoperative complications in patients after adrenalectomy for pheochromocytoma.